Urban Built Environments and Trajectories of Disability Among Older Adults

说明(申请人提供)：老年人特别依赖当地社区，由于健康和功能状况下降、经济压力和社会孤立，他们很容易受到城市建成环境中的障碍(例如交通拥挤、人行道不安全和缺乏行人便利设施)的影响。然而，建筑环境对老年人独立性的影响还没有得到充分的研究。这项研究的目的是了解建筑环境在残疾进展中的作用。具体地说，该项目的目标有三个：1)详细描述社区老年人高危人群周围的建成环境；2)检查建成环境与残疾进展之间的关系；3)确定随着时间的推移，居住在较不方便的社区的老年人是否更有可能入住养老院。研究目标将通过使用定量多水平方法和地理信息系统(CIS)软件相结合的基于现有人口的数据(密歇根州家庭护理最低数据集)的二级数据分析计划来调查。潜在轨迹类别分析将被用来检查城市可达性和城市设计对15个月期间行动不便和随后的疗养院入院轨迹的影响。适当使用地理信息系统和空间分析技术进行这项研究所需的技能将作为职业发展计划的一个关键组成部分获得。候选人将利用密歇根大学和其他地方的广泛资源和培训机会，获得必要的技能，以追求在人们老龄化的更大社会和环境背景下适当地将以人为中心的变量置于研究生涯中。目前关于晚年健康和独立性的研究几乎完全侧重于个体层面的因素。然而，周围环境的作用可能在塑造老年人的独立和依赖模式方面发挥关键作用。该项目致力于实现疾病预防控制中心的健康保护目标之一--“健康场所的健康人”，重点是为有残疾风险的老年人定义健康社区的建成环境的设计。

DESCRIPTION (provided by applicant): Older adults are particularly dependent on their local communities, and due to declining health and functional status, financial strain and social isolation, are vulnerable to barriers in the urban built environment (e.g. heavy traffic, unsafe sidewalks, and a lack of pedestrian amenities). Yet the effect of the built environment on independence in older adults is under-studied. The purpose of this research is to understand the role of the built environment in disability progression. Specifically, the aims of this project are threefold: 1) to characterize in detail the surrounding built environment for a high risk population of community-dwelling older adults; 2) to examine the relationship between the built environment and disability progression; and 3) to identify whether older adults living in less accessible neighborhoods are more likely to be admitted to a nursing home over time. The research objectives will be investigated through a program of secondary data analysis with existing population-based data (Michigan Minimum Data Set for Home Care) using a combination of quantitative multilevel methods and geographic information systems (CIS) software. Latent trajectory class analysis will be used to examine the effect of urban accessibility and urban design on trajectories of mobility disability and subsequent nursing home admission over a 15 month period. The skills needed to appropriately use GIS and spatial analysis techniques for this research will be obtained as a key component of the career development plan. The candidate will draw on a broad range of resources and training opportunities throughout the University of Michigan and elsewhere, to obtain the necessary skills to pursue a research career that appropriately situates person-centered variables within the larger social and environmental context in which people age. Current research on later life health and independence places almost exclusive emphasis on factors at the individual level. Yet, the role of the surrounding environment may play a key role in shaping patterns of independence and dependence among older adults. This project addresses one of CDC's Health Protection Goals, "Healthy People in Healthy Places", by focusing on the design of built environments that define healthy communities for older adults at risk for disability.